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i <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS _ <br /> n> <br /> OOWNERV <br /> Gl/✓Es/7- �f,Fi.9u//Lr TELEPHONE )�j <br /> MAILING ADDRESS/✓ <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTIONS y),G�� <br /> TYPE OF PERMTHS): SINGLE-FAMILY D 1LLIN AAD ONO DECK 0 GARAGE/ACCESSORY STRUCTURE- <br /> BUNKHOUSE 0 59.692(IV)GAZEBO C STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMME/RCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE: <br /> /� z/ (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: J S <br /> A <br /> A PLOT PIAN MUST BE PROVIDED ON AN 8 V.X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PIANS Ew <br /> WILL BE RETURNED. <br /> n <br /> DIRECTIONS FOR PLOT PUN DRAWING: (ARIAL OR TOP VIEW) <br /> L ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. f - <br /> '2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW C7 <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, J <br /> AND INDICATE NORTH(N). QD 'c z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF UKE, STRUM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. .: <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES = <br /> TO BUILDINGS, ROADS, LAKE,LOT LINES, I� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PUNNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE _� y <br /> PUNS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. b <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C7 IA <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER f <br /> SETBACK AREA. TIS <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. S <br /> 6. <br /> 2. <br /> n 2 _ ' 3 '` cir <br /> I declare Nat this application(including E ' 2 ' <br /> (i g dcom let.. I accompanying been examined r the <br /> the F e jaP .�.. <br /> knowledgeandbeliefiiistrue,isa mrnrctand Complete. 1acknowledge MatTul responsibleforthedetailandecog.i.eofall - _ - - - - <br /> information contained i ing will be relied! (includingpbyheny accompanying of Burne Wisconsin in I t rmining whe t whether <br /> issue a e permit. <br /> I <br /> furtheaccepam providing will be relietl upon by the County of Burnett Wisconsin Inde[erminingwM1eMer[o issuespermitl <br /> further accept an lability Nat may result of the county of Burnett relying on this information l am providing In this - <br /> application. I agreetopermit a Ticialsch rgedwi administratagcountyardinancesor 00 rauthoridelperson to 1� p <br /> have access to the above deur' remises an able time for the purpose of inspection. \\II ? o- > <br /> U oy <br /> OWNER'S SIGNATURE <br /> (date) n c <br /> ZONING ADMINISTRATOR SEP I I ZV -- - - - <br /> Ci0 < t t e r <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ZONING Q o <br /> V 38 8 <br />